| NPI | 1356606073 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME123527) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301100991) |
| Enumeration Date | 2012-07-09 |
| Last Update Date | 2021-08-19 |